Maternal Antibodies to Chlamydia trachomatis and Risk of Gastroschisis

Abstract

Background Gastroschisis, a birth defect of the abdominal wall, is increasing in prevalence. The largest increase in prevalence has been observed among young mothers (<20 years). The prevalence of Chlamydia trachomatis (CT) infection is highest among young women and has also been increasing over time. The objective was to investigate the association between immunoglobulin G antibodies to Chlamydia trachomatis (CT) (anti-CT) and Chlamydial heat shock protein 60 (anti-CHP60) during pregnancy, and risk of gastroschisis among offspring. Methods We conducted a nested case–control study of 292 gastroschisis cases identified from the Congenital Malformations Register and 826 live born controls matched on age and birth year within the Finnish Maternity Cohort. Early pregnancy serum samples were used to categorize women by seropositivity to anti-CT and anti-CHP60. Women seronegative for anti-CT and anti-CHP60 served as the reference. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Effect measure modification by maternal age (<25 years, ≥25 years) was also assessed. Results Seropositivity to anti-CT (17.8% of cases vs. 16.0% of controls) or anti-CHP60 (23.6% of cases vs. 22.0% of controls) was not associated with gastroschisis. Although, the OR for seropositivity to anti-CT alone was slightly elevated (OR, 1.19; 95% CI, 0.73–1.94), specifically among young mothers (<25 years) (OR, 1.65; 95% CI, 0.81–3.37), the results were imprecise. Conclusion Chlamydia infection, as measured by immunoglobulin G antibodies to CT and CHP60, is not associated with gastroschisis, however, our assays were not able to distinguish recent infection.

Risk of gastroschisis with maternal genitourinary infections: the US National birth defects prevention study 1997–2011

“…A recent study21 noted a fourfold increased risk for gastroschisis among women with seropositivity during pregnancy to anti- C. trachomatis IgG 3 , suggesting a role for recent STI due to C. trachomatis . However, in a Finnish cohort, no association was observed between C. trachomatis- specific IgG and gastroschisis,22 though a twofold increased risk was observed with presence of antibodies to herpes simplex virus type 2 (HSV-2) during early pregnancy 23…”

Nuevas pistas para comprender la gastrosquisis. Embriología, patogénesis y epidemiología

“…It is worth noting that these columnar cells become squamous with increasing age, which decreases the pathogen-cell affinity and the probability of infection. The results of Feldkamp et al 31 differ from those previously published by Parker et al 33 , for the first trimester of gestation, in that the latter found no association between reactivity in terms of IgG against the pathogen or against the chlamydial heat shock protein CHP60, which should reflect the chronicity of the infection with Chlamydia trachomatis .…”

“…However, taking into account that until a few decades ago women were mothers at an early age but there was no growing global prevalence that the malformation currently shows 30 , maternal age must be considered simultaneously with other prevalent factors in very young women, related to exposure to various exogenous agents such as tobacco, alcohol or illicit drugs, as well as the early initiation of sexual activity and the acquisition of genitourinary infections. In this regard, epidemiological findings have shown that infections acquired shortly before or during the first trimester of gestation, such as urinary and sexually transmitted infections, are similarly associated with gastroschisis, possibly through a pathway that involves the immune response 31 - 33 . In a case-control study, Feldkamp et al 31 , reported that the risk of malformation doubled and even increased up to 25 times in the case of maternal age less than 20 years or smoking.…”

“…Sin embargo, teniendo en cuenta que hasta hace unas pocas décadas las mujeres eran madres a edades tempranas y no existía la prevalencia global creciente que en la actualidad muestra la malformación 30 , la edad materna debe ser considerada simultáneamente con otros factores prevalentes en mujeres muy jóvenes, relacionados con exposición a diversos agentes exógenos como tabaco, alcohol o drogas ilícitas, así como con el inicio temprano de la actividad sexual y la adquisición de infecciones genitourinarias. A este respecto, hallazgos epidemiológicos han mostrado que, infecciones adquiridas poco tiempo antes o durante el primer trimestre de la gestación, como las urinarias y las de transmisión sexual, están asociadas en forma similar con la gastrosquisis, posiblemente a través de una vía que involucra a la respuesta inmune 31 - 33 . En un estudio de casos y controles, Feldkamp et al 31 reportaron que el riesgo de la malformación se duplicaba y aún aumentaba hasta 25 veces, en caso de edad materna inferior a 20 años o tabaquismo.…”

Trans-Placental Transmission and Survival at Birth among Neonates of Chlamydia trachomatis Infected Mothers: A Cohort Study

“…Some studies have suggested that this pathogenic effect of CT infection may also play an important role in stillbirths (7,23). CT antibodies were reported to be higher in mothers who had stillbirths compared to mothers with live births (4,7,(24)(25)(26).…”